AB0014 IMMUNE RESPONSES TO VACCINATION AGAINST HERPES ZOSTER (HZ) IN PATIENTS WITH RHEUMATIC DISEASES UNDER TREATMENT WITH JAK-INHIBITORS: OUR PRELIMINARY RESULTS
Authors: C. Sieiro Santos, A. López Robles, C. Álvarez Castro, S. Calleja Antolín, C. Moriano, E. Diez Alvarez, J. M. Garcia Ruiz de Morales
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Shingrix is a recombinant inactive vaccine available for prevention of herpes zoster (HZ) infection, recently approved for patients with rheumatic diseases under treatment with JAK-inhibitors. Because of its novelty, scant information is available on Shingrix vaccine responses in patients with immune mediated rheumatic diseases (IMRD). <h3>Objectives</h3> To investigate the antibody responses to the HZ vaccine in selected rheumatic diseases treated with JAK-inhibitors (JAKi) pre- and post-Shingrix vaccination (weeks 4–6) and to identify factors associated with reduced immunogenicity. <h3>Methods</h3> Patients with selected rheumatic diseases under treatment with JAKi underwent two series of IM Shingrix vaccine (0.5mL each) administered 2 months apart. Bloodwork was performed 4-8 weeks following 2<sup>nd</sup> dose of vaccine to assess post- vaccination antibody response. Pre and post vaccination response was then compared using Anti Varicella Zoster Virus IgG Multiplex Flow Immunoassay (MFI). Blood lymphocyte distributions (CD3+, CD4+, CD8+, CD19+) and NK cells, total serum IgG and IgM levels, and VZV-IgG and IgM, were investigated pre- and post-Shingrix vaccination (weeks 4–6). <h3>Results</h3> 38 patients were included, 79% were female with a median age at inclusion of 57±10.5 years. 21% of patients had rheumatoid arthritis, 8% had systemic lupus erythematosus, 16% had psoriatic arthritis, 16% had ankylosing spondylitis and 5% had dermatomyositis. VHZ IgG antibody levels and distributions of lymphocyte subpopulations in peripheral blood pre- and post-immunization are represented in Table 1. Positive humoral responses were observed in 86% of patients. Mean changes VHZ-IgG antibody between post- and pre-vaccination sera were 4.6±0.33 and 1.8±1.98 (p&lt;0.0001), respectively. After immunization, the number of T cells (CD3+, CD4+, CD8+) and NK cells remained relatively unchanged however, the number of B cells (CD19+) increased significantly from 147.4±156 to 780.62±475.5 significantly (p&lt;0.0001). There was a 2.5-fold increase in antibody titers after immunization in RA patients, a 2.4-fold increase in SLE patients, a 2-fold increase in AP patients, a 2.5-fold increase in AS patients and a 3.5-fold increase in DM, with no significant difference between the different patients' subgroups. Results from multivariate regression analysis adjusted by age, gender, disease duration, treatments and glucocorticoid and MTX cumulative dose, showed a negative correlation between VHZ-IgG and age &gt;65 years (β=-0.34, p 0.03), disease duration (β=-0.58, p 0.04) and glucocorticoid cumulative dose (β=-0.42, p 0.02). <h3>Conclusion</h3> Our preliminary results show preserved seroconversion rates and VHZ-IgG antibodies and concurrently increase the number of CD19+ B-cells and total serum IgG in patients with rheumatic diseases on treatment with JAKi. Age&gt;65 years, disease duration and glucocorticoid cumulative dose are negatively correlated with humoral response. <h3>Reference</h3> [1]Källmark H, Gullstrand B, Nagel J, Einarsson J, Jönsson G, Kahn F, Kahn R, Bangtsson A, Bergström T, Kapetanovic M. Immunogenicity of Adjuvanted Herpes Zoster Subunit Vaccine in Rheumatoid Arthritis Patients Treated with Janus Kinase Inhibitors and Controls: Preliminary Results [abstract]. <i>Arthritis Rheumatol.</i> 2020; 72 (suppl 10). <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.